Purpose The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes. Design/methodology/approach The paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework. Findings The framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate. Practical implications These include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level. Originality/value This paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.

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The main conclusion is that this population have many risk factors which increase the possibility of developing serious mental health problems, therefore highlighting the need for early intervention.

It has been proposed that affective instability may be associated with thoughts about self-injury. The aim of this study was to test the hypotheses that instability in feelings of depression, but not anxiety, guilt, or hostility, would predict greater concurrent and subsequent thoughts about self-injury. Thirty-six individuals with psychosis completed questions on touch-screen mobile phones at semi-random times each day for one week. The instability of depression predicted greater concurrent and subsequent levels of thoughts about self-injury, even when controlling for depression level. Conversely, self-injurious thoughts predicted more stable depression. The instability of guilt, anxiety, and hostility did not significantly predict levels of thoughts about self-injury. Results indicate that a variable depressive state may trigger the onset of thoughts about self-injury, which increases the risk of its subsequent recurrence. The onset of self-injurious thoughts may, however, have a stabilizing effect on subsequent depression.

The main objective in the use of computer-based systems which dynamically order hospital waiting lists is to produce a more systematic and clinically acceptable pattern of selection from the waiting list than that resulting from traditional manual systems. This has been achieved previously through the evaluation of fairly complex mathematical formulae which require detailed analysis to modify their behaviour pattern, and thus separate the clinician from direct control of the system.This paper describes a waiting list management system which uses a conceptually simple ordering process based on waiting time limits set by the clinician for each planned clinical procedure relevant to the specialty. The clinician receives periodic analyses of the current performance of the process and can easily control the behaviour pattern by changing the limits for any procedure. The system also keeps account of allocated bed and theatre resources.Use of this waiting list management system in a Urology Department has resulted in a significant shift in the composition of the waiting list and in a more equitable pattern of selection from the waiting list;. In addition, the time spent by the clinician in managing the waiting list has been considerably reduced.